National Cholesterol Education Program

Adult Treatment Panel III (ATP III) Guidelines Slide Set

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SLIDE 1: National Cholesterol Education Program
Adult Treatment Panel III (ATP III) Guidelines

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SLIDE 2: Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (ATP III)
Members

• Scott M. Grundy, M.D., Ph.D. (Chair)
  University of Texas Southwestern Medical Center at Dallas
• Diane Becker, Sc.D., M.P.H.
  The Johns Hopkins University
• Luther T. Clark, M.D.
  State University of New York, Brooklyn
• Richard S. Cooper, M.D.
  Loyola University Medical School
• Margo A. Denke, M.D.
  University of Texas Southwestern Medical Center at Dallas
• Wm. James Howard, M.D.
  Washington Hospital Center
• Donald B. Hunninghake, M.D.
  University of Minnesota
• D. Roger Illingworth, M.D., Ph.D.
  The Oregon Health Sciences University
• Russell V. Luepker, M.D., M.S.
  University of Minnesota
• Patrick McBride, M.D., M.P.H.
  University of Wisconsin Hospital and Clinics
• James M. McKenney, Pharm.D.
  National Clinical Research
• Richard C. Pasternak, M.D., F.A.C.C.
  Massachusetts General Hospital
• Neil J. Stone, M.D.
  Northwestern University School of Medicine
• Linda Van Horn, Ph.D, R.D.
  Northwestern University Medical School

Ex-Officio Members

• H. Bryan Brewer, Jr., M.D.
  National Heart, Lung, and Blood Institute
• James I. Cleeman, M.D. (Executive Director)
  National Heart, Lung, and Blood Institute
• Nancy D. Ernst, Ph.D., R.D.
  National Heart, Lung, and Blood Institute
• David Gordon, M.D., Ph.D.
  National Heart, Lung, and Blood Institute
• Daniel Levy, M.D.
  National Heart, Lung, and Blood Institute
• Basil Rifkind, M.D.
  National Heart, Lung, and Blood Institute
• Jacques E. Rossouw, M.D.
  National Heart, Lung, and Blood Institute
• Peter Savage, M.D.
  National Heart, Lung, and Blood Institute

Consultants

• Steven M. Haffner, M.D.
  University of Texas Health Science Center, San Antonio
• David G. Orloff, M.D.
  Food and Drug Administration
• Michael A. Proschan, Ph.D.
  National Heart, Lung, and Blood Institute
• J. Sanford Schwartz, M.D.
  University of Pennsylvania
• Christopher T. Sempos, Ph.D.
  State University of New York, Buffalo

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SLIDE 3: National Cholesterol Education Program Coordinating Committee
Agency for Healthcare Research and Quality
American Academy of Family Physicians
American Academy of Insurance Medicine
American Academy of Pediatrics
American Association of Occupational Health Nurses
American Association of Office Nurses
American College of Cardiology
American College of Chest Physicians
American College of Nutrition
American College of Obstetricians and Gynecologists
American College of Occupational and Environmental Medicine
American College of Preventive Medicine
American Diabetes Association, Inc.
American Dietetic Association
American Heart Association
American Hospital Association
American Medical Association
American Nurses Association
American Osteopathic Association
American Pharmaceutical Association
American Public Health Association
American Red Cross
Association of Black Cardiologists
Association of State and Territorial Health Officials
Centers for Disease Control and Prevention
Citizens for Public Action on Blood Pressure and Cholesterol, Inc.
Coordinating Committee for the Community Demonstration Studies
Health Resources and Services Administration
National Black Nurses Association, Inc.
National Cancer Institute
National Center for Health Statistics
National Heart, Lung, and Blood Institute
National Medical Association
NHLBI Ad Hoc Committee on Minority Populations
Office of Disease Prevention and Health Promotion
Society for Nutrition Education
Society for Public Health Education
U.S. Department of Agriculture
U.S. Department of Defense
U.S. Department of Veterans Affairs (VA)
U.S. Food and Drug Administration

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SLIDE 4: National Cholesterol Education Program Reports

• Adult Treatment Panel I (1988)
  Adult Treatment Panel II (1993)
  Adult Treatment Panel III (2001)
• Recommendations for Improving Cholesterol Measurement (1990)
• Recommendations on Lipoprotein Measurement (1995)
• Population Strategies for Blood Cholesterol Reduction (1990)
• Blood Cholesterol Levels in Children and Adolescents (1991)

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SLIDE 5: New Features of ATP III
Focus on Multiple Risk Factors

• Diabetes: CHD risk equivalent
• Framingham projections of 10-year CHD risk
  • Identify certain patients with multiple risk factors for more intensive treatment
• Multiple metabolic risk factors (metabolic syndrome)
  • Intensified therapeutic lifestyle changes

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SLIDE 6: New Features of ATP III (continued)
Modification of Lipid and Lipoprotein Classification

• LDL cholesterol <100 mg/dL-optimal
• HDL cholesterol <40 mg/dL
  • Categorical risk factor
  • Raised from <35 mg/dL
• Lower triglyceride classification cut points
  • More attention to moderate elevations

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SLIDE 7: New Features of ATP III (continued)
New Recommendation for Screening/Detection

• Complete lipoprotein profile preferred
  • Fasting total cholesterol, LDL, HDL, triglycerides
• Secondary option
  • Non-fasting total cholesterol and HDL
  • Proceed to lipoprotein profile if TC 200 mg/dL or HDL <40 mg/dL

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SLIDE 8: New Features of ATP III (continued)
More Intensive Lifestyle Intervention (Therapeutic Lifestyle Changes=TLC)

• Therapeutic diet lowers saturated fat and cholesterol intakes to levels of previous Step II
• Adds dietary options to enhance LDL lowering
  • Plant stanols/sterols (2 g per day)
  • Viscous (soluble) fiber (10-25 g per day)
• Increased emphasis on weight management and physical activity

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SLIDE 9: New Features of ATP III (continued)
New strategies for Promoting Adherence
In both:

• Therapeutic Lifestyle Changes (TLC)
• Drug therapies

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SLIDE 10: New Features of ATP III (continued)

• For patients with triglycerides 200 mg/dL
  • LDL cholesterol: primary target of therapy
  • Non-HDL cholesterol: secondary target of therapy
    
    Non HDL-C=total cholesterol - HDL cholesterol

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SLIDE 11: Cost-Effectiveness Issues

• Therapeutic lifestyle changes (TLC)
  • Most cost-effective therapy
• Drug therapy
  • Dominant factor affecting costs
  • Cost effectiveness: one factor in the decision for drug therapy
  • Declining price of drugs: increases cost effectiveness

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